Battling The 'Bad Actor' Known As C. Diff.

This article will appear in the upcoming March print issue of Surgical Products.

Every hospital facility has a “bad actor,” says Dr. Mitch Rubinstein.

For The Valley Hospital, a fully-accredited acute care, not-for-profit hospital based in Ridgewood, NJ, that bad actor – a microorganism that causes trouble within a specific hospital facility – is Clostridium difficile. Dr. Rubinstein, the hospital’s Vice President of Medical Affairs, is quick to note the facility employs a comprehensive infection prevention program. However, all of the components that make up that program – hand hygiene, barrier precautions, environmental services practices, the use of appropriate bleach products, among others – aren’t enough to effectively deal with the problem of C. diff at the facility, which holds 451 beds and serves approximately 44,000 people throughout 32 towns in Bergen County.

“We utilize luminescent marking to evaluate our EVS practices and conduct additional training as needed,” says Dr. Rubinstein. “We also have an aggressive antibiotic stewardship program in place – but we believed we could do better with the help of new room disinfection technologies.”

The hospital approached its potential investment in this technology by assembling a committee to properly evaluate available room disinfection options. The committee looked closely at vaporization and other UV technologies before selecting a room disinfection system from Xenex. According to Dr. Rubinstein, the committee eventually determined vaporization technology was too labor intensive for a high-occupancy facility like The Valley Hospital. A key concern throughout the decision-making process was the amount of time it would take for each product to eliminate C. diff. Some called for room treatment times of approximately one hour, but the Xenex device was able to destroy C. diff in less than five minutes.

“As a result of the Xenex room disinfection system, we’ve avoided a lot of infections,” says Dr. Rubinstein.

However, the performance of a particular product or piece of technology cannot be properly evaluated without factoring in the cost of that performance. As a result, when the Xenex system was being considered as a viable investment option, Dr. Rubinstein put together a pro forma that demonstrated the ROI the facility could achieve with the Xenex technology. When weighed against the cost of infections, the pro forma indicated, the price to obtain the devices would be covered if there was even a “modest reduction” in the prevalence of infections at the facility. However, The Valley Hospital has tracked its C. diff infection rate since the start of 2012, and it has seen a 35 percent decrease from the first quarter of 2012 to the fourth quarter of 2013.

“We know that C. diff rates tend to be higher in Q1 but these results demonstrated to us that we clearly had a decrease in C. diff infections when the Xenex devices were used to disinfect our rooms,” says Dr. Rubinstein. “That’s a huge leap forward for patient safety.

“We’ve seen a $120,000 savings over two years,” he continues. “That’s significant and very exciting.”

The decision to purchase five devices was based on a number of factors, including the hospital’s size, number of discharges per day, and other clinical priorities.

“The device only needs 5-10 minutes per room, but we are a high-occupancy hospital,” says Dr. Rubinstein. “(We) recognized that we needed more than one device in order to hit all the rooms we were targeting without significantly adding to our room turnaround time.”

More than anything, however, the hospital made the decision based on the speed and frequency with which the technology could be used.

The Valley Hospital initially focused its efforts on isolation room discharges, the intensive care unit, the cardiac care unit, and operating rooms. As time went on, however, the technology was employed in additional rooms. In order to gain the best possible results from infection prevention efforts, the five devices are now strategically positioned all around the facility for daytime use during terminal room cleans. Furthermore, they are also utilized in the hospital’s emergency department rooms for priority cleans throughout all hours of the day. During the evening, they are used in ORs and special procedure rooms, such as catheter labs and endoscopy suites.

“Semi-private rooms were a challenge, but we worked closely with hospital administration and nurse management to develop a communication system to identify when a room was discharged that needed to be treated with the Xenex device,” says Dr. Rubinstein. “We made sure we had a process in place to quickly vacate the room for treatment without inconveniencing the other patient. And we trained the entire staff to run the devices to ensure that there was always someone available to treat a room.”

Effective communication and teamwork have been critical to the successful implementation of the Xenex devices into the facility’s comprehensive infection prevention program. According to Dr. Rubinstein, the interconnected working relationships between the hospital’s infection control department, EVS department, and Xenex have been incredibly important. Xenex trained the facility’s EVS staff, closely monitored usage and results information, and has maintained consistent involvement over time.

“As a result, and with the success we’ve had, our infection prevention program has the support of the highest levels of our administration and trustees,” he says. “Infection reduction success doesn’t happen overnight,” Dr. Rubinstein continues. “The hospital has to have a team approach to solving the problem. And you have to use the devices in order for them to be effective.”